UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Acute Angle Closure Attacks Are Uncommon in Primary Angle-Closure Suspects: The Zhongshan Angle Closure Prevention Trial

Friedman, David S; Chang, Dolly S; Jiang, Yuzhen; Huang, Shengsong; Kim, Julia A; Munoz, Beatriz; Aung, Tin; ... Foster, Paul J; + view all (2022) Acute Angle Closure Attacks Are Uncommon in Primary Angle-Closure Suspects: The Zhongshan Angle Closure Prevention Trial. Ophthalmology Glaucoma 10.1016/j.ogla.2022.04.003. (In press).

[thumbnail of Foster_Acute Angle Closure Attacks Are Uncommon in Primary Angle-Closure Suspects_AAM.pdf] Text
Foster_Acute Angle Closure Attacks Are Uncommon in Primary Angle-Closure Suspects_AAM.pdf
Access restricted to UCL open access staff until 12 May 2023.

Download (179kB)

Abstract

PURPOSE: Angle-closure glaucoma is a major cause of blindness worldwide that carries an excessive risk of severe, bilateral visual impairment. A common concern among clinicians is the precipitation of acute angle-closure (AAC) attacks because of mydriasis. We evaluated the risk of AAC after pharmacologic dilation in Chinese individuals classified as having bilateral primary angle-closure suspects (PACSs). DESIGN: Randomized, interventional, controlled trial. PARTICIPANTS: A total of 889 patients with bilateral PACSs, aged between 50 and 70 years, were identified through community screening in Guangzhou, China, and enrolled in the study. METHODS: In the Zhongshan Angle-Closure Prevention Trial, bilateral PACSs were treated with laser peripheral iridotomy (LPI) in 1 randomly selected eye, with the fellow eye serving as an untreated control. Over 72 months of follow-up, the participants had their pupils pharmacologically dilated 6 times with 5% phenylephrine and 0.5% tropicamide. MAIN OUTCOME MEASURES: Incidence and risk of post-mydriasis AAC in LPI-treated and untreated, control eyes classified as PACSs. RESULTS: One bilateral AAC attack occurred after mydriasis at the 2-week post-LPI visit. No other AAC events occurred in the LPI-treated eyes. In the untreated eyes, 4 additional attacks occurred: 2 occurred after dilation (1 at 54 months and 1 at 72 months of follow-up) and 2 occurred spontaneously. The risk of post-mydriasis AAC in the untreated eyes was 1 attack in 1587 dilations. The risk of spontaneous AAC in the untreated eyes was 0.44 per 1000 eye-years (95% confidence interval, 0.11-1.77 per 1000 eye-years). CONCLUSIONS: The risk of incident AAC attacks in PACSs was extremely low, even in a higher-risk group that underwent repeated pharmacologic pupillary dilation over 6 years of follow-up. Prophylactic LPI reduced this small but real risk. This trial was registered at ISRCTN.com as ISRCTN45213099.

Type: Article
Title: Acute Angle Closure Attacks Are Uncommon in Primary Angle-Closure Suspects: The Zhongshan Angle Closure Prevention Trial
Location: United States
DOI: 10.1016/j.ogla.2022.04.003
Publisher version: https://doi.org/10.1016/j.ogla.2022.04.003
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Angle-closure, Glaucoma, Laser peripheral iridotomy, Mydriasis
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10149091
Downloads since deposit
1Download
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item